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Dumitru M, Vrinceanu D, Banica B, Cergan R, Taciuc IA, Manole F, Popa-Cherecheanu M. Management of Aesthetic and Functional Deficits in Frontal Bone Trauma. Medicina (B Aires) 2022; 58:medicina58121756. [PMID: 36556958 PMCID: PMC9781007 DOI: 10.3390/medicina58121756] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and scooters. Usually, the patients are involved in high-velocity accidents and the resulting lesions could be life-threatening. Moreover, there are immediate and long-term aesthetic and functional deficits resulting from such pathology. The immediate complications range from local infections in the frontal sinus to infections propagating inside the central nervous system, or the presence of cerebrospinal fluid leaks and vision impairment. We review current trends and available guidelines regarding the management of cases with frontal bone trauma. Treatment options taken into consideration are a conservative attitude towards minor lesions or aggressive surgical management of complex fractures involving the anterior and posterior frontal sinus walls. We illustrate and propose different approaches in the management of cases with long-term complications after frontal bone trauma. The team attending to these patients should unite otorhinolaryngologists, neurosurgeons, ophthalmologists, and maxillofacial surgeons. Take-home message: Only such complex interdisciplinary teams of trained specialists can provide a higher standard of care for complex trauma cases and limit the possible exposure to further legal actions or even malpractice.
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Affiliation(s)
- Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Bogdan Banica
- OMF Surgery Department, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Romica Cergan
- Anatomy Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence:
| | - Iulian-Alexandru Taciuc
- Department of Pathology, “Carol Davila” University of Medicine and Pharmacy, 050096 Bucharest, Romania
| | - Felicia Manole
- Department of ENT, Faculty of Medicine, University of Oradea, 410073 Oradea, Romania
| | - Matei Popa-Cherecheanu
- Department of Cardiovascular Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania
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Zima LA, Srinivasan S, Budde B, Kitagawa R. Thirty-two nails injected into the head: An operative report and review of the literature. Surg Neurol Int 2022; 13:377. [PMID: 36128153 PMCID: PMC9479502 DOI: 10.25259/sni_512_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Self-inflicted nail gun injuries are a rare phenomenon that can result in traumatic damage. The velocity of the nail is generally fast enough to penetrate the skull. However, the extent of damage depends on the exact angle and structures of the brain encountered by the nails. Case Description: A 55-year-old male presented with 32 nails in the head and was found down. Initially, the patient presented with localization but had to be intubated soon after due to declining condition. This report describes the operative technique for safe removal of all nails, separated into six categories based on location and structures of the brain encountered. A review of literature revealed potential complications such as hemorrhage and infections and how to protect against these undesired effects. Conclusion: Self-inflicted nail gun head injuries are an uncommon form of traumatic head injury. Some important tools that helped prevent our patient from developing major complications included stereotactic navigation, antibiotic prophylaxis, and angiography to carefully monitor for vascular injuries.
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Affiliation(s)
- Laura A. Zima
- Department of Neurosurgery, UT Houston, Houston, Texas, United States
| | - Subhiksha Srinivasan
- UT Health Houston, McGovern Medical School, UT Houston, Houston, Texas, United States
| | - Brad Budde
- Department of Neurosurgery, UT Houston, Houston, Texas, United States
| | - Ryan Kitagawa
- Department of Neurosurgery, UT Houston, Houston, Texas, United States
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Encarnacion-Ramirez MDJ, Aquino AA, Castillo REB, Melo-Guzmán G, López-Vujnovic D, Blas A, Acosta-Garcés R, Bernés-Rodríguez M, Guerra RM, Ayala-Arcipreste A, Nurmukhametov R, Efe IE. Surgical management of a penetrating drill bit injury to the skull base. Surg Neurol Int 2022; 13:49. [PMID: 35242415 PMCID: PMC8888304 DOI: 10.25259/sni_1229_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Low-energy penetrating brain injuries are rarely encountered in neurosurgical practice. Immediate surgical management remains the primary treatment strategy to control potential bleeding and prevents infectious complications. Case Description: A 28-year-old man presented with an orbital injury with left-sided chemosis, amaurosis, and ophthalmoplegia following an assault. Cranial CT revealed an industrial drill bit causing a penetrating injury to the skull base. The tip of the object reached the petrous apex. CT angiography showed no signs of cerebrovascular damage. The drill bit was visualized through a frontotemporal craniotomy. It was then carefully removed under direct microscopic vision. Postoperative ceftriaxone was administered. The patient was discharged in good condition on postoperative day 6. His vision impairment remained. Conclusion: Timely access to neuroimaging diagnostics and microneurosurgical facilities allows for good outcomes in the surgical treatment of low-velocity penetrating brain injuries.
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Affiliation(s)
| | - Amaya Alvarez Aquino
- Department of Neurosurgery, International Center for Neurological Restoration, Havanna, Cuba, Mexico,
| | | | | | | | - Agustin Blas
- Department of Neurosurgery, Hospital Juárez de México, Mexico-City, Mexico,
| | | | | | | | | | - Renat Nurmukhametov
- Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation,
| | - Ibrahim E. Efe
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
- Centre for Surgery Zurich, Klinik Hirslanden, Zurich, Switzerland
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